The Continued Need For Tactical Emergency Care in Law Enforcement

On March 23 2010, Las Vegas Metro Police Officer Mike Madland and his partner Chris LeBlanc chased an armed robbery suspect. As the robber hurdled walls and fences, the three ended up in a backyard of a residence. During the shooting that followed, Mike was struck twice — once in the chest, a round which was stopped by his vest and once in his leg, which severed a femoral artery. On August 5, 2010 Mike, among other Metro cops, was honored for his actions that day. Still requiring extensive physical therapy, his survival and attitude were an inspiration to the audience.

Madland’s ability to beat the odds is direct result of his Warrior mindset, his own training, and the abilities and help provided by LeBlanc and other responding officers. After the suspect was killed, Mike’s partners realized the severity of his injury. They applied and maintained direct heavy pressure on the wound. His partners rushed Mike to the hospital, trying to keep that pressure, the whole route.

As Sheriff Gillespie noted during the ceremony, “If he arrived at the hospital any later, or if these officers did not put pressure on the artery at the scene, Officer Madland possibly would not have lived.”

Survival on the Streets

On October 29, 2005 Fairfax County Police Officers Pete Fiegleson and Scott McCaskill responded to an apartment complex for a “man with a gun” call. After the apparent suicide-by-cop incident was over, Fiegleson was wounded in the upper-right leg. Another round — traveling over the ballistic shield held by McCaskill — grazed the top of his head, and for a brief moment took him out of the fight. But training, common sense, and presence of mind prevailed. Fiegleson realized that his injury might be severe and the artery may be damaged. Looking at his downed partner, he held his own pressure on the leg. “You’re lying in a gun battle, you need to move,” he would later say of his thought process during the incident. “My goal was to live for ten minutes… so that Paramedics would help me.”

On January 20th 2011, Cleveland’s Officer Anthony Sauto came face to face with a stolen-car suspect wielding a Mac 9 with a 30-round magazine. As the thief sprayed led with no concern for anyone around, Sauto was struck in the leg. Anthony was rushed to the hospital by his partners, for an injury that just missed his femoral artery. It was described as “likely would have proven deadly.”

There are just a few examples of what happens all over the country every single day.

Cops are hurt, lose time from families and work, get serious disabilities, and die, from injuries which could have been addressed on scene through proper training and equipment. Is it always by a firearm? Of course not. Though firearms are primary tools being noted in officer assaults, its knives, fists, flying glass, dogs, and whatever else the dirt bag can find. It’s not always a leg or a femoral artery, as in the above examples. In fact, preliminary research is starting to quantitatively show that we have to contend with more torso-level injuries, despite the presence of armor. A simple web search will return hundreds of cases, with all types of weapons and injuries. That’s just the information available publicly or to popular media. Hundreds more incidents go unreported.

Fiegleson wanted to make it “ten minutes.” How much time do we have in an instance like that?

Well, if you’re talking about the response time of available traditional EMS resources, often it’s longer than “ten minutes.” But, if it’s the amount of time one has when a major artery is injured… Well, we’re looking at three- to five-minute timeframe to do something, before complete bleed out or death occurs. At the least, we’ll have to worry about our own, or our partner’s severe shock, which is harder still to effectively address by immediately available means. So, when the argument is that “the Paramedics will be there in five,” keep that in mind. Add to the equation the fact that once on scene (or perimeter), they may not physically get to you for at least five or ten minutes more. Now, we’re presented with a real problem.

Let’s get one thing out in the open, and agree on it right now. Sometimes, it’s completely out of our hands. We do everything right — tactically, professionally, and personally. Sometimes, the injury might as well have occurred in the vestibule of the operating room, and there is still little that can be done. As long as we are involved in what is clearly a combat working environment, we will suffer loses. With that said, the events and numbers in the two and a half months of 2011 offer no encouragement.

We’ve lost 43 police officers as of this writing, and are praying for those who have lived through recent events and whose recovery remains uncertain. If someone thinks that their small town or community is immune from violence like this, I beg to differ.

I will be the first to argue that we need and must have, Tactical Medicine and Tactical Combat Casualty Care skills and equipment instilled in all cops, from the recruit academy on. But, I believe we can not afford to cut corners or fill in the gaps through knee-jerk reactions. Sometimes we are just plain pissed off at what’s happening with violence against our officers, but, when emotions work their way into training designs, we are setting up ourselves for failure.

Preparation is tactical, not knee jerk. Every training must be properly designed, sustained and appropriately progressive. In this day and age, we don’t need a substitute for what is already proven to work. What I mean is this. We absolutely must train and practice the applications of improvised tourniquets. That is, looking at our surroundings, try and pre-plan what might work if you need one. But in doing so, the understanding of what a tourniquet does and how it achieves the desired effect must be in place first. So when you have a piece of clothing or a belt, you opt for those, instead of a radio wire. The later, being more damaging in the inappropriate application, rather then helpful.

The same recognition must accompany with the understanding of when to apply any tourniquet, or an alternate form of bleeding control. It only makes sense that we seek out and secure proper training and equipment. Yes, I am saying spend the $29 out of pocket and have the commercially endorsed tourniquet available — as in, with you — at all times. It has almost earned household acceptance in our jargon and some training circles, that we can apply a tourniquet and use it as a first line intervention. Yet, as recently as this week I met a medical professional who thought that it will result in irreversible limb damage, and an officer will not have ample time to apply it. Please, do your research, and whatever you decide, use the facts.

It should take 15-25 seconds to apply a commercially-available and endorsed tourniquet such as a CAT or SOF-T, with the SOF-T Wide being the preferred and latest model. You will usually find the right tools like these at only a few reputable vendors. It has worked, and will work for you if applied properly. The point is, get the right training! Get the right equipment! Good medicine can mean bad tactics, regardless of the provider. For that matter, let’s not forget the basics. Talking to an injured partner and trying to calm the breathing and slow blood flow, should parallel other tactics.

There is no reason why, with all other factors being equal, a femoral injury should be fatal. Not today!

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About The Author

Rob has been in public service for some 17 years, holding several specialized assignments, and becoming a law enforcement and emergency services instructor. He has 10 years in the military and currently serving as a reservist, fire team leader and medic. He enjoys learning, writing, doing grunt work, and helping other vets in need. To further that goal, they started Grunt’s BBQ and Easy Company. A future mobile chow hall, coming to an AO near you.